Israeli doctors perform life-saving heart surgery on 4-year-old Syrian refugee from war-torn Homs • As the boy recovers, his father says: "The man we thought loved us is trying to kill us and the supposed enemy saves my son's life. I could live here."

Adi Rubenstein

Hamoudi with his father and Dr. Dudi Mishali at Sheba Medical Center, Tel Hashomer

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Photo credit: Liron Almog

Four-year-old Mahmoud, or Hamoudi (cute one), as he is nicknamed, has begun to fit in well in the hallways of the Pediatric Cardiology Unit at Sheba Medical Center, Tel Hashomer. Wearing a track suit from an Israeli company, he jumps energetically on the gymboree and runs up and down the corridor, sometimes stopping for a snack of apple chips. Children from Petach Tikva, Jerusalem and other places play with him, though without words, only with the natural dynamic of children.

None of the children or their parents knows that Hamoudi, who is busy jumping on the colorful cushions, is a Syrian refugee. These youngsters were never supposed to meet, but the world has its own ways of making children laugh together in unexpected places.

Hamoudi's father, barely 30, looks at his son with a shy smile. If somebody had told him four years ago that Israeli doctors, of all people, would save the life of his son, who was born with a rare, life-threatening heart defect, he would not have believed it.

Hamoudi's father remembers the moment he was in his small shop in the Syrian city of Homs when the first rumors of armed conflict between Assad's opponents arrived. At first the rumors seemed distant and unimportant. He was busy taking care of Hamoudi, whose right and left ventricles were reversed.

When the British cardiologist in the clinic in Damascus examined Hamoudi during the first weeks of his life, he said that not even heart surgery would give him more than a few years of life. Then his family, who refused to believe that Hamoudi was living on borrowed time, found themselves dealing with a far graver problem: The fighting reached Homs, and their city was under artillery fire.

Many of Hamoudi's relatives were killed during the first weeks of fighting in Homs. The family home was damaged by a direct hit from a shell fired by Assad's army. In the ensuing chaos, fear and panic, the family decided to do what tens of thousands of other Syrians were doing, and fled to one of the borders -- with Jordan, Lebanon, Turkey or Iraq. When Hamoudi's father and mother crossed the border (to protect the family's identity, we are not mentioning which one it was), they settled in a refugee camp, where their situation grew worse still. The locals regarded them with suspicion, and survival was impossible. A refugee family receives a grant of $150 per month, which is not enough for four people (by this time, Hamoudi had a younger sibling).

But even in the impossible conditions of the refugee camp, the family kept dreaming about a better future for Hamoudi. Rumors came from the refugee camps throughout the Middle East, particularly about what was happening on Israel's Syrian border, on the Golan Heights, where many people who had been wounded in the fighting were being given medical treatment in Israel. For the first time, Hamoudi's family had the option of seeking help from the country they had been taught to hate and fear most of all.

Hamoudi's father says, "We always heard in the Arab media how children from the Gaza Strip and the West Bank were receiving medical treatment in Israel. When the stories began to come from Syria, I believed with all my heart that Mahmoud would also go for treatment there. I knew that was what was supposed to happen." But with the way things were in the refugee camp, a journey to Israel would be possible only with the right combination of luck and good will.

The good will was provided by a Christian organization called Shevet Achim, which works from Jerusalem and employs volunteers from all over the world. When periodic medical examinations at the refugee camp showed beyond all doubt that Hamoudi's life was in danger, Shevet Achim's coordinator, Jonathan Miles, made arrangements for him to undergo surgery in Israel.

It was late in the previous coalition's term, and the former interior minister, Eli Yishai, unenthusiastic over what could be a precedent-setting idea, asked for financial guarantees. But time passed, and about two weeks ago, with fairly good cooperation between Shevet Achim and the Israeli Interior Ministry, the proper permits arrived, signed by Interior Minister Gideon Sa'ar.

With no passports or visa, Hamoudi was taken to Israel for examination, treatment and rapid surgery at Sheba Medical Center, Tel Hashomer. Dr. Dudi Mishali, director of pediatric cardiac surgery at the hospital, and Dr. Shai Tejman-Yarden, who heads its pediatric arrhythmia clinic, were updated on Hamoudi's condition before he arrived.

"We had two options," Mishali said. "The first was to go with an easier operation, which would have given him another 15 to 20 years of life. If he had been 60 years old, for example, that would have been the best option, and we would have said we had done him a great favor. But we felt that for a 4-year-old, that option would be cruel and unfair to him and his family."

So Mishali and his team chose to perform the most complicated surgery available for Hamoudi's condition. This option was fraught with danger, an all-or-nothing proposition.

"The operation is called a double switch," says Dr. Mishali, "because we use a highly complex procedure to change the direction of the ventricles and the arteries."

Before the operation, the doctors prepared Hamoudi's father for all possible outcomes, including the worst. His mother, who remained in the refugee camp with their younger son, received updates by telephone. All they could do was pray. Hamoudi, supported by Shevet Achim volunteers from Denmark and the United States and by the hospital staff, did not understand why everyone was fussing over him.

The eight-hour operation was a success. A state-of-the-art pacemaker made by the Medtronic medical devices company -- whose vision also includes working across borders -- was implanted in Hamoudi's heart. The pacemaker contains a battery that will enable it to last for many years, much longer than other pacemakers, since no one knows when Hamoudi will next be able to receive thorough medical treatment or regular follow-up.

'I would like to live here'

Mishali, the nurses and the entire staff of the unit still get excited when they see Hamoudi running around and smiling so soon after the operation. Hamoudi is more mature than most children his age, perhaps because of the constraints of a wartime childhood in a refugee camp and the tragedy that has befallen his country.

Hamoudi was supposed to stay under observation for two weeks in the intensive-care unit. But just two days afterward, he amazed everyone by jumping out of bed, running among the hospital units, gorging himself on sweets and asking for his mother.

"Now that the operation is over, he is a child like any other. His life expectancy is exactly like yours or mine," Mishali said.

Mishali wears the skullcap of a religiously observant Jew and a plaid shirt beneath his scrubs. He is particularly short of time this week, since he came back from performing 10 heart operations on teenagers in Nigeria to a backlog of work at the hospital.

A volunteer wherever he is needed, Mishali comes back to the unit at Tel Hashomer, where children not only from Israel but from the entire Middle East await him. "These are the moments in my work that give me the drive to get up for work every morning," he says, smiling. "I see this as my mission."

The children in the Pediatric Cardiology Unit have already seen every possible response: Some parents have knelt to kiss the physicians' feet, others have broken into song and dance in the hospital corridors, and still others have fallen weeping on the surgeons' necks, refusing to let go. But Hamoudi's father holds back, mostly from shyness and fear. He does not know Israel, and if he ever thought he did, he is learning about it anew.

"Israel is a very good place," he says, first making sure that we will not give his name or publish his photograph. "I would like to live here. But I know it will be difficult. Nobody knows when the war in Syria will end, and in the meantime we live in uncertainty."

Every day he is here, he is surprised by the treatment he and his son receive.

"All our lives, we were taught to love one person and hate another," he says. "Now the one we learned to love is trying to kill us, and the one that is supposed to be my enemy has saved my son's life. The people on the Syrian street do not hate Israel, and I'm sure that is how the Israeli people feel about Syria."

Soccer in Jerusalem

Hamoudi's father speaks about the extremely harsh conditions in the refugee camp. Shevet Achim's volunteers, who visit the many refugee camps, say, "The world is looking away once more. For the people of Syria, it is inconceivable that after so much time, the whole world is not interested in what is happening there, and people have already begun dealing with other things."

According to Hamoudi's father and the volunteers, life in the camps is bleak. At first, the Jordanians and the Lebanese opened their doors to Syria's war refugees, but now their patience is wearing thin. On the one hand, there is the human desire to help people whose homes were destroyed and whose families were murdered. But on the other, the Arab countries fear the far-reaching economic repercussions of taking in so many refugees.

Survival in the camps is very difficult, Hamoudi's father says. Everybody is looking for jobs, and willing to work in subpar conditions to provide for their families. The Syrian families live in tiny apartments, for which they are asked to pay a higher rent than the local population, and the fact that they have no legal status that would allow them to work or plan for their future makes their struggle harder still.

They also miss their country as it used to be, and the family members they left behind.

"This week, we saw photographs of the snow in Homs on Facebook," Hamoudi's father says. "That was rare, but I do not know whether we will ever go back, or what will happen to us in the future."

Before leaving Syria, Hamoudi's father was a devoted soccer fan, even taking Hamoudi to games played by the local team, which often won championships. Hamoudi is already a discerning soccer fan who, like his father, admires the well-known Portuguese player Cristiano Ronaldo. The Shevet Achim volunteers say that on the long evenings at the convalescent home in Jerusalem where they stay, Hamoudi's father sometimes gathers the children for a game of soccer, and the volunteers join in as well.

Who is your friend?

Hamoudi is the first Syrian refugee to have a planned operation in Israel (others refugees have been treated for war-related injuries). But of course, not every story like his has a happy ending. Just this week, an Iraqi baby died after waiting 40 days for a heart operation that was to have been performed in Israel. A delay in the issue of his entry permits sealed his fate, and his heart stopped 15 hours before he was to enter the operating room.

"Unfortunately, there are such cases. In an attempt to find consolation, I tell myself that these are the slaps God gives us to remind us, the doctors, that we are not God and we should not get too far above ourselves," Mishali said.

He chooses to concentrate on the cases where he succeeded in saving the child's life "without it making any difference to us who he is or where he is from."

"There have already been situations where, during one day of a military operation, we operated on a child from the Gaza Strip, and the next day we operated on the son of a pilot from Ramat Hasharon. That is when I think, as a doctor, that when I see this father's tears of happiness or that one's, does it really matter to me which is which?" he said.

"The happiness of a mother and father is happiness in any language. It needs no translation. Our real mission is here. There is no feeling like this one, that we saved the life of a child, whoever he may be and wherever he may be from."

Even though Hamoudi's condition is good, Shevet Achim's volunteers know of more work to be done. A Syrian 17-year-old needs urgent cardiac surgery, but the wheels of bureaucracy turn slowly.

"This is the essence of 'You shall love your neighbor as yourself,'" says coordinator Miles. "Together with the staff of the Israeli hospital, we define who 'your neighbor' is, and our goal is that everyone realize that people are people, certainly when it comes to children. For the members of Shevet Achim, the answer is clear, though for the State of Israel, it is more complex."

In the small physicians' room at Tel Hashomer sits a surgeon in a skullcap, a group of devout Christians and a bleary-eyed and battle-weary Muslim father. On the warm floor between them sits a little boy, drawing with colored marker pens on stationery with the Sheba Medical Center's letterhead at the top.

Before we part, I ask Hamoudi if he knows a bit of Hebrew. The only Hebrew Hamoudi knows is "Shabbat shalom." His favorite moment of the week, which he chose during the short time he has been in Israel, is the Friday night service welcoming the Sabbath. In the hospital, he murmurs the word "Shabbat" to himself, a shy blush rising in his cheeks.